• Journal of Korean Neurosurgical Society
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• 제54권4호
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• pp.347-349
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• 2013

We report a very rare case of cervical compressive myelopathy by an anomalous bilateral vertebral artery (VA) entering the spinal canal at the C1 level and compressing the spinal cord. A 70-year-old woman had been suffering from progressive gait disturbance. Magnetic resonance imaging revealed that a bilateral VA at the V4 segment had abnormal courses and caused compression to the high cervical cord. VA repositioning was performed by anchoring a suture between the artery and around the arachnoid membrane and dentate ligament, and then, microvascular decompression using a Teflon sponge was done between the VA and the spinal cord. The weakness in the patient improved in the lower extremity after the operation. Anomalous VA could be one of the rare causes of cervical compressive myelopathy. Additionally, an anchoring suture and microvascular decompression around the VA could be a sufficient and safe method to indirectly decompress the spinal canal.

• Journal of Korean Neurosurgical Society
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• 제48권3호
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• pp.298-300
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• 2010

Authors describe a patient who developed a myelopathy associated with Guillain-Barr$\'{e}$ syndrome and cervical myelopathy. We provide radiological evidence of non-compressive herniated cervical intervertebral disc with cord signal changes and show the clinical and electrophysiological result of coexisting Guillain-Barr$\'{e}$ syndrome and cervical myelopathy. We tried to introduce and review the case of Guillain-Barr$\'{e}$ syndrome which was combined with cervical myelopathy to let us recollect the presumptive cause.

• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.436-440
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• 2014

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.

• 보험의학회지
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• 제27권2호
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• pp.107-111
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• 2008

The Cervical spondylotic myelopathy (CSM) is degenerative compressive myelopathy which initiation of symptoms seems to be induced by minor cervical trauma or spontaneous event. There was a case of Claim medical examination which was requested to discriminate the cause of ambulatory quadriparesis. Patient asserted that the onset of his myelopathy was followed by minor trauma. The author considered the medical recordings, MRI scan, Claim reports by claim manager. The space available for cord was the smallest at C3-4 level. But on MRI findings, the spinal cord at C3-4 level seemed to be already damaged. There were no recent injury evidences such as hemorrhages, spinal cord contusions, edema, soft tissue hemorrhages. If the space available for cord was small enough to compress the spinal cord, the serious neurologic deficits, non-ambulatory quadriplegia, etc were commonly induced by cervical extension trauma. Patient's asserts did not correspond to his clinical course after cervical trauma. The author reports a case of medical examination for the relationship between symptom onset of cervical spondylotic myelopathy and minor trauma within author's experience.

• Journal of Korean Neurosurgical Society
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• 제29권7호
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• pp.891-898
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• 2000

Objective : It is difficult to differentiate intramedullary spinal cord tumors preoperatively from non-neoplastic pathologies in patients presenting as non-compressive myelopathies in magnetic resonance imaging(MRI). In this report, the authors reviewed nonneoplastic intramedullary spinal cord lesions preoperatively diagnosed as tumors and discussed their clinical and radiological characteristics and usefulness of surgical intervention. Methods : From January, 1985 to January, 1999, authors experienced eight non-neoplastic pathologies mimicking intramedullary spinal cord tumors and analysed their medical records, radiological findings and histopathological specimens retrospectively. Results : There were five males and three females and the duration of symptoms were from two to 20 months(mean, 9.8 months). The location of lesions were four cervical, one cervicothoracic and three thoracic. All patients manifested sensory abnormality, seven motor weakness, and six bladder symptom. All cases had swollen spinal cords and increased signal intensities in spin-echo sequences. Six cases showed contrast enhancement : four cases were focal and two diffuse. Under the impression of intramedullary tumors, the patients were operated upon. Final diagnoses on the base of clinical and pathologic finding were : three subacute necrotizing myelopathies, two multiple scleroses, two myelopathy of unknown etiology. One case showed no gross abnormality in surgical field in spite of adequate exposure of the lesion, so biopsy was not performed. In that case, postoperative MRI revealed spontaneous resolution of the lesion. Conclusion : MRI is invaluable diagnostic tool in screening myelopathies. However, its high sensitivity and lack of specificity make difficulty in preoperative differential diagnosis of non-compressive myelopathies. Although no surgical morbidity occurred in our series, we sometimes failed to confirm definite diagnosis even with biopsy. In such a circumstance, long-term follow up is needed.

• Journal of Korean Neurosurgical Society
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• 제50권4호
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• pp.392-395
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• 2011

Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a rare inflammatory disease characterized by hypertrophic inflammation of the dura mater and various clinical courses that are from myelopathy. Although many associated diseases have been suggested, the etiology of IHSP is not well understood. The ideal treatment is controversial. In the first case, a 55-year-old woman presented back pain, progressive paraparesis, both leg numbness, and voiding difficulty. Initial magnetic resonance imaging (MRI) demonstrated an anterior epidural mass lesion involving from C6 to mid-thoracic spine area with low signal intensity on T1 and T2 weighted images. We performed decompressive laminectomy and lesional biopsy. After operation, she was subsequently treated with steroid and could walk unaided. In the second case, a 45-year-old woman presented with fever and quadriplegia after a spine fusion operation due to lumbar spinal stenosis and degenerative herniated lumbar disc. Initial MRI showed anterior and posterior epidural mass lesion from foramen magnum to C4 level. She underwent decompressive laminectomy and durotomy followed by steroid therapy. However, her conditions deteriorated gradually and medical complications occurred. In our cases, etiology was not found despite through investigations. Initial MRI showed dural thickening with mixed signal intensity on T1- and T2-weighted images. Pathologic examination revealed chronic nonspecific inflammation in both patients. Although one patient developed several complications, the other showed slow improvement of neurological symptoms with decompressive surgery and steroid therapy. In case of chronic compressive myelopathy due to the dural hypertrophic change, decompressive surgery such as laminectomy or laminoplasty may be helpful as well as postoperative steroid therapy.

• Journal of Korean Neurosurgical Society
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• 제52권1호
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• pp.27-31
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• 2012

Objective : Although hydroxyapatite (HA) spacer has been used for laminoplasty, there have been no reports on factors associated with fusion and on the effects of HA shape. Methods : During January 2004 and January 2010, 45 patients with compressive cervical myelopathy underwent midline-splitting open door laminoplasty with winged (33 cases) and wingless (12 cases) HAs by a single surgeon. Minimal and mean follow up times were 12 and 28.1 months, respectively. Japanese Orthopedic Association (JOA) score was used for clinical outcome measurement. Cervical X-rays were taken preoperatively, immediately post-operatively, and after 3, 6, and 12 months and computed tomography scans were performed preoperatively, immediately post-operatively and after 12 months. Cervical lordosis, canal dimension, fusion between lamina and HA, and affecting factors of fusion were analyzed. Results : All surgeries were performed on 142 levels, 99 in the winged and 43 in the wingless HA groups. JOA scores of the winged group changed from $10.4{\pm}2.94$ to $13.3{\pm}2.35$ and scores of the wingless group changed from $10.8{\pm}2.87$ to $13.8{\pm}3.05$. There was no significant difference on lordotic and canal dimensional change between two groups. Post-operative 12 month fusion rate between lamina and HA was significantly lower in the winged group (18.2 vs. 48.8% p=0.001). Multivariate analysis showed that ossification of the posterior longitudinal ligament, male gender, and wingless type HA were significantly associated with fusion. Conclusion : Clinical outcome was similar in patients receiving winged and wingless HA, but the wingless type was associated with a higher rate of fusion between HA and lamina at 12 months post-operatively.

• Asian Spine Journal
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• 제12권6호
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• pp.1078-1084
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• 2018

Study Design: Prospective observational study. Purpose: This prospective analysis aimed to evaluate the efficacy and bone-bonding rate of hybrid hydroxyapatite (HA) spacers in expansive laminoplasty. Overview of Literature: Various types of spacers or plates have been developed for expansive laminoplasty. Methods: Expansive open-door laminoplasty was performed in 146 patients with cervical myelopathy; 450 hybrid HA spacers and 41 autogenous bone spacers harvested from the spinous processes were grafted into the opened side of each lamina. The patients were followed up using computed tomography (CT), and their bone-bonding rates for hybrid HA and autogenous spacers, bone-fusion rates of the hinges of the laminae, and complications associated with the implants were then examined. Results: Clinical symptoms significantly improved in all patients, and no major complications related to the procedure were noted. The hybrid HA spacers exhibited sufficient bone bonding on postoperative CT. The hinges completely fused in over 95% patients within 1 year of the procedure. Only 4 spacers (0.9%) developed lamina sinking, and most expanded laminae maintained their positions without sinking or floating throughout the follow-up period. Conclusions: Hybrid HA spacers contributed to high bone-fusion rates of the spacers and hinges of the laminae, and no complications were associated with their use. Cervical laminoplasty with these spacers is safe and simple, and it yields sufficient fixation strength while ensuring sufficient bone bonding during the immediate postoperative period.

• Annals of Clinical Neurophysiology
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• 제10권2호
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• pp.109-111
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• 2008

Ossification of the ligamentum flavum (OLF) usually occurs in the lower thoracic spine, and is rare in the cervical region. We report the case of a 67-year-old woman who presented a seven month's history of progressive weakness and paresthesia in her right upper extremity. MRI and CT scans of the spine revealed the presence of ossified ligamentum flavum from C3-C4. A cervical laminectomy resulted in a good post-operative improvement of muscle strength.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.454-457
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• 2010

Pure ventral midline giant schwannoma is an extremely rare entity. Spinal intradural extramedullary schwannomas commonly occur posterolateral or anterolateral to the spinal cord. A case of a pure midline ventrally situated giant pan cervical extramedullary schwannoma in an 18-year-old male patient with compressive myelopathy and sphincter involvement is presented. Spinal MR imaging showed a midline ventrally situated extramedullary tumor with severe spinal cord compression extending from clivus to C7 vertebra. It was resected through a posterolateral approach. Histology was consistent with a schwannoma. Post operative MR imaging showed no evidence of the tumor. The radiological features, pathogenesis and surgical strategies in management of these difficult tumors are discussed and the relevant literature is briefly reviewed.